Alarm fatigue occurs when one is exposed to a large volume of alarms and as a result, one can become desensitized to the firing alarms. Desensitization can lead to longer response times or missing important alarms. Alarm fatigue occurs in many industries including construction, mining, and healthcare.
The constant sounds of alarms and noises from blood pressure machines, ventilators and heart monitors causes a “tuning out” of the sounds due to the brain adjusting to stimulation. This issue is present in hospitals, in home care providers, nursing homes and other medical facilities alike. The Joint Commission's sentinel event reports 80 alarm-related deaths and 13 alarm-related serious injuries over the course of a few years. On Apr. 18, 2013, the Joint Commission issued a sentinel event alert that highlighted the widespread problem of alarm fatigue in hospitals. The Joint Commission recommended establishing guidelines to tailor alarm settings, training all members of the clinical team on safe use of alarms, and sharing information about alarm-related incidents. This alert has since turned into a National Patient Safety Goal for 2014 to improve the safety of clinical alarm systems. This Goal will force hospitals to establish alarm safety as a priority, identify the most important alarms, and establish policies to manage alarms by January 2016.
Hospitals across the country are looking for ways to reduce the threat. Alarms that are more critical, i.e. heart rate, oxygenation, are usually louder, sound at a higher pitch, and sound more rapidly. Less critical alarms may sound at a lower and slower pitch. Other hospitals have a centralized monitoring station where an individual or individuals are only responsible for monitoring critical heart rate monitors.
ECRI (Emergency Care Research Institute), a not-for-profit organization dedicated to patient safety, outlines the following strategies for managing alarm fatigue. They suggested strategies like using a multidisciplinary team to review the issues, review events and near misses, take time to observe how alarms are responded to, ask nurses and other healthcare providers about their concerns, identify vulnerabilities and implement both short and long term fixes to the problem.
Strategies related to ECG monitoring include improving skin prep to reduce lead failure, routinely change electrodes, replace batteries regularly and to raise the priorities of the alarms relating to the disconnection of leads from the patient's body. Other considerations include delineating who is responsible for what alarms, identify back up coverage and response.